Mississippi Adolescent Center
NPI #1376840058 in Brookhaven, Mississippi
Provider Information
- NPI Number
- 1376840058
- Entity Type
- Organization
- Organization Name
- Mississippi Adolescent Center
- Primary Specialty
- Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Feb 16, 2011
- Last Updated
- Feb 16, 2011
Practice Location
- Address
- 760 BROOKMAN DRIVE EXTENSION
- City
- Brookhaven
- State
- Mississippi
- ZIP Code
- 39601-2340
- Phone
- (601) 823-5700
Authorized Official
- Name
- MR. EDWIN C. LEGRAND, M.A.
- Title
- EXECUTIVE DIRECTOR, MISSISSIPPI DEP
- Phone
- (601) 359-1288
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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